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Concerns raised about maternity care in rural areas

LANSING – Almost 2.5 million women of childbearing age living in rural America face higher risks during pregnancy and childbirth, including some who are forced to drive at least an hour to give birth in a hospital, a study in the journal “Health Affairs” found.

The study found that 45 percent of rural U.S. counties had no hospital obstetric services at all, leaving more than half of all rural U.S. counties without hospital obstetric services.

This comes at a time when the maternal mortality rate in the United States increased by more than 25 percent from 2000 to 2014, according to a 2016 study in the “Obstetrics and Gynecology Journal.”

The Michigan Department of Health and Human Services’ Maternal Mortality Surveillance Committee estimated in a January report that approximately 80 women die each year in the state during pregnancy and childbirth.

Patrice Bobier, a midwife from Oceana County and member of the board of the Michigan Midwives Association, said the trend in hospitals closing their obstetric care departments could be because they struggle to balance their books.

Hospitals increasingly find themselves having to merge with bigger corporations or health institutions, bringing their maternity operations to a halt, Bobier said.

Bobier has been working as a midwife since 1982. But in the last three years, she noted an increase in women giving birth through her midwifery services..

The situation in the Upper Peninsula is particularly critical, with fewer obstetrical units than other areas in the state.

UP Health System Marquette is the only hospital in the U.P. with a neonatal intensive care unit.

Obstetricians in the hospital often travel to nearby hospitals to provide obstetric services, said Emily Wright, physician relations specialist at UP Health System in Marquette.

To address this situation, the Michigan Maternal Mortality Surveillance Committee endorsed six recommendations in September.

For example, the committee will seek to enhance education and coordination between the state Board of Licensed Midwifery and midwives attending out-of-hospital births about timely referrals of women to hospitals when necessary.